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protectourcare
In Fact Sheet, Research

FACT SHEET: How High Drug Costs Hurt Seniors

Protect Our Care Releases New Fact Sheet As Part of Lower Rx Summer

Today, Protect Our Care is kicking off Week 3 of Lower Rx Summer with a fact sheet underscoring how high drug costs hurt seniors. Throughout the week, Protect Our Care will host events and release additional research to demonstrate the urgency for reform to bring down drug prices for seniors.

Remaining Theme Weeks for Lower Rx Summer

Week 3 (June 21): How High Drug Prices Hurt Seniors

Week 4 (June 28): How High Drug Prices Hurt Women

Week 5 (July 5): How High Drug Prices Hurt People with Disabilities

Week 6 (July 12): How High Drug Prices Hurt People of Color

Week 7 (July 19): How High Drug Prices Hurt Small Businesses

Week 8 (July 26): How High Drug Prices Hurt Children

Seniors are at the center of the drug pricing crisis. Nearly 9 in 10 Americans over the age 65 take prescription medications, with many struggling with serious conditions such as diabetes, arthritis, and cancer. As many as one in four seniors, or more than 10 million seniors nationwide struggle to afford prescription drugs, with higher rates among more vulnerable groups, including low-income seniors, people of color, and those in poor health. It is unconscionable that seniors and older adults in this country are forced to make impossible choices between purchasing essential medicines and buying food or paying rent. 

Yet every day, drug companies profit off of seniors. Drugmakers are raking in record profits and spending millions on lobbying to block reform while continuing to hike the prices of lifesaving medications. A recent analysis from the Kaiser Family Foundation found that half of all drugs covered by Medicare Part D, or 1,646 drugs, had price increases averaging 3.5 times the rate of inflation between 2018 and 2019. This translates to hundreds, if not thousands, in additional out-of-pocket costs for patients — simply unworkable for seniors with fixed incomes. Research shows that even a modest increase in out-of-pocket costs can have deadly consequences for patients, who are forced to skip doses or forgo medications altogether due to rising costs. 

High drug prices demonstrate the urgent need to give Medicare the power to negotiate for lower drug prices. In 2019, the House of Representatives passed the Lower Drug Costs Now Act (H.R. 3), historic legislation that would lower drug prices for all patients, not just those covered under Medicare. H.R. 3 would save patients over $150 billion and reduce the price of the costliest drugs by as much as 55 percent. 

Not only does giving Medicare the power to negotiate help seniors at the pharmacy counter, but it would save the federal government nearly $500 billion, which could be reinvested to strengthen health care for seniors and older adults. These savings could help lower premiums, expand coverage, establish an out-of-pocket cap for drug costs, and strengthen Medicare benefits to include hearing, vision, and dental. As the nation recovers from the coronavirus pandemic, ensuring access to affordable health care, and specifically prescription drugs, has never been more critical. 

KEY POINTS

    • Millions of seniors are struggling to afford medications as drug companies are raking in major profits. 89 percent of Americans over 65 take prescription medications, with one in four struggling to afford drug costs. Meanwhile, pharmaceutical companies are experiencing record profits and breaking records for the money they are spending on K Street lobbyists to block legislation to lower prices for seniors. Research shows Big Pharma could lose $1 trillion in sales and still be the most profitable industry. 
    • Despite record profit, drug manufacturers continue to exploit a broken system by hiking prices at the expense of our seniors. In January 2021, drugmakers hiked the price of nearly 1,000 drugs. Between 2018 and 2019, 1,646 drugs covered by Medicare Part D experienced price increases averaging 3.5 times the rate of inflation. These surging drug costs are particularly difficult for the 50 percent of Medicare beneficiaries living on annual incomes below $29,650. 
  • Growing out-of-pocket drug costs put the lives of seniors at risk. Medicare has no cap on out-of-pocket prescription drug costs. A 2021 study found that increasing out-of-pocket drug costs by only $10 created a 33 percent increase in mortality, due to a decrease in medication accessibility. Biogen’s debut of Aduhelm, a new Alzheimer’s treatment slated to cost $56,000 per year with over $10,000 in out-of-pocket costs to patients, demonstrates the reckless greed of the pharmaceutical industry. 
  • Americans don’t trust Big Pharma to play fair. Nearly 75 percent of Americans do not trust drug manufacturers to set fair pricing for prescription drugs and nine in ten believe the federal government should have the power to negotiate with drug companies to lower the price of prescription drugs for Medicare recipients. 

Rising Prescription Drug Costs Disproportionately Impact Seniors

Nearly Nine In Ten Seniors Currently Take Prescription Medication, With Millions Struggling To Afford The Cost. One in four adults over 65 report difficulty affording their prescription drugs. Seniors most likely to experience difficulty are: in poor health, have an annual household income under $30,000, and/or take four or more prescription medications. 

Prescription Drug Prices Continue To Outpace Inflation. Between 2018 and 2019, 1,646 drugs covered by Medicare Part D experienced price increases averaging 3.5 times the rate of inflation.

The Most Essential Medications Are Often The Most Expensive. With the high cost of specialty medications, it should come as no surprise that 80 percent of prescriptions that seniors report struggling to afford are for the treatment of ‘somewhat serious’ or ‘very serious’ health conditions. One million Medicare Part D beneficiaries spend more than Part D’s catastrophic coverage threshold, paying an annual out-of-pocket average of $3,200. Patients taking prescription drugs for treatment of cancer, hepatitis C, multiple sclerosis, and rheumatoid arthritis face some of the most extreme costs. The average out-of-pocket cost for 11 oral prescription cancer drugs was $10,470 in 2019. 

Most Medicare Beneficiaries Live On A Fixed Income. In 2019, 50 percent of Medicare recipients had incomes under $29,650. With average out-of-pocket costs for specialty medications surpassing $8,000, many seniors are faced with the impossible decision of filling their prescriptions or paying for other basic needs. 

Growing Out-Of-Pocket Prescription Costs Limit Medicare Beneficiaries’ Access To Drugs

Medicare Has No Out-Of-Pocket Limit For Prescription Drugs. Individuals on Medicare are the only insured Americans to have no cap for out-of-pocket medication costs. Once Medicare beneficiaries are out of the coverage gap and have obtained catastrophic coverage, they are still responsible for coinsurance and copayments costs.

Out-of-Pocket Costs For Specialty Medications Are Skyrocketing. Even with catastrophic coverage, Medicare Part D enrollees can face thousands of dollars in out-of pocket expenses for specialty drugs. Kaiser Family Foundation anticipated the average 2019 out-of-pocket cost for specialty drugs to be $8,109. 

High Out-of-Pocket Costs Force Seniors To Forgo Medications. One in five seniors report not taking their medications as prescribed due to cost. A 2021 study found that increasing out-of-pocket costs by only $10 created a 23 percent decrease in Medicare beneficiaries taking prescription drugs as instructed, as well as a 33 percent increase in mortality. 

Seniors Are Forced To Put Off Retirement To Access Needed Drugs. Without a limit on out-of-pocket costs for prescriptions, many older Americans continue working to retain access to employer insurance plans which offer additional coverage. Postponing the transition to Medicare also allows for the continuation of financial assistance from pharmaceutical manufacturers, not available to Medicare beneficiaries.

Americans Don’t Trust Big Pharma And Support Efforts To Bring Down Drug Prices 

Americans Hold Big Pharma Responsible For High Costs. 80 percent of Americans believe the profits of drug manufacturers are a leading contributor to the unreasonably high price of prescription medication. As a result, nearly 75 percent of Americans do not trust pharmaceutical corporations to set a fair price for their prescription drugs. 

Seniors Want Action From Congress. 82 percent of seniors support the federal government negotiating lower prescription drug prices for Medicare recipients and nearly 70 percent favor an annual cap on out-of-pocket drug costs for those on Medicare.

There Is Strong Support For Drug Price Negotiation. Nine in ten Americans agree the federal government should have the power to negotiate with drug companies to lower the price of prescription drugs for Medicare recipients. 

Seniors Support Basing Drug Prices On Amounts Paid In Other Countries. 60 percent of older Americans favor tying what Medicare pays for prescription drugs to the amounts paid by other countries. The CommonWealth Fund found that H.R. 3 would create a maximum price for any negotiated drug by tying it to the cost in other countries and penalizing manufacturers who fail to agree to prices set by HHS.

protectourcare
In Fact Sheet, Research

FACT SHEET: Taking Action To Reduce Drug Prices Will Not Harm Innovation

Protect Our Care Releases New Fact Sheet As Part of Lower Rx Summer

Today, Protect Our Care is kicking off Week 2 of Lower Rx Summer with a fact sheet debunking one of Big Pharma’s most powerful scare tactics: that any meaningful legislation to reduce drug prices will harm the development of new medications. Throughout the week, Protect Our Care will host events and release additional research to push back on Big Pharma’s biggest lies.  

Protect Our Care recently announced Lower Rx Summer as part of The Campaign to Reduce Drug Prices. Lower Rx Summer consists of themed weeks of action to demonstrate the urgent need for legislation to lower drug prices principally by giving Medicare the power to negotiate with drug companies for lower prices for all Americans. 

Remaining Theme Weeks for Lower Rx Summer

Week 2 (June 14): Pushing Back on Big Pharma’s Lies

Week 3 (June 21): How High Drug Prices Hurt Seniors

Week 4 (June 28): How High Drug Prices Hurt Women

Week 5 (July 5): How High Drug Prices Hurt People with Disabilities

Week 6 (July 12): How High Drug Prices Hurt People of Color

Week 7 (July 19): How High Drug Prices Hurt Small Businesses

Week 8 (July 26): How High Drug Prices Hurt Children

Fact Sheet: Taking Action To Reduce Drug Prices Will Not Harm Innovation

As Big Pharma prepares to fight upcoming legislation to lower drug prices, it is ramping up some of its most powerful scare tactics: that if prices were regulated through Medicare negotiation and other reforms, patients would lose out on lifesaving new drugs. That argument is simply false. In reality, high U.S. drug prices far exceed what is necessary to fund research and development. Instead, drug companies use price hikes to reward CEOs and shareholders. Moreover, research and development is heavily subsidized by taxpayers. 

KEY POINTS

  • Americans pay more for prescription drugs than anyone in the world. On average, Americans pay nearly three times more for medications than people in 32 other countries. 
  • Drug prices continue to skyrocket as profits are higher than any other industry. Big Pharma is enjoying record profits and breaking records for the money it’s spending on K Street lobbyists to block any legislation to lower prices for patients. In January 2021, drugmakers hiked the price of nearly 1,000 drugs, with increases far outpacing inflation. Research shows that drug companies could lose $1 trillion in sales and still be the most profitable industry. 
  • Higher profits do not correspond with increased research & development. Drug companies saved billions thanks to former President Trump’s tax bill. Instead of making meaningful investments in research and development, drug companies rewarded their executives and shareholders. 
  • Price hikes rarely correspond with increased clinical value. Time and again, drug companies hike the prices of drugs without any added benefit to patients. 
  • Taxpayers subsidize the creation of new drugs. Americans are being charged twice for high drug costs: first, as taxpayers funding research and development, and then again at the pharmacy counter. 
  • The development of COVID-19 vaccines were largely funded by taxpayers, not pharmaceutical companies. More than $19 billion in government funding has been invested in COVID-19 vaccines.

For the full fact sheet, click here. 

protectourcare
In Fact Sheet

How The American Rescue Plan Strengthens Medicaid Coverage

April is Medicaid Awareness Month. On March 11, President Biden signed the American Rescue Plan into law, historic legislation that includes the most significant health care expansion in a decade. After four long years of Republican efforts to sabotage the Affordable Care Act (ACA) and Medicaid, President Biden and Democrats in Congress are now working to expand coverage, lower costs, and reduce racial disparities in health care. 

In addition to providing affordable coverage options for millions of uninsured Americans through the ACA, the American Rescue Plan provides robust financial incentives for the 14 states that have not yet implemented Medicaid expansion. The legislation also includes important measures to strengthen Medicaid coverage and benefits. Medicaid has served as a critical safety net as millions have lost jobs and their employer-based health insurance during the pandemic. Unsurprisingly, Medicaid enrollment has grown to an all-time high of 77 million Americans. Between February and November 2020, states that expanded their programs saw a 22 percent increase in Medicaid enrollment. 

The American Rescue Plan: 

Incentivizes Medicaid Expansion. The American Rescue Plan includes an offer too good for Republican holdout states to turn down: In addition to covering 90 percent of the costs for the expansion population, the federal government would chip in an extra 5 percent for the traditional Medicaid population for two years. This translates to billions in additional dollars for the states — more than enough to cover the cost of expansion itself. Research confirms that Medicaid expansion increases access to care, improves financial security, and leads to better health outcomes. 

  • Four million uninsured adults could gain coverage if remaining holdout states expand Medicaid. The Urban Institute estimates that more than 6 million people could enroll in Medicaid coverage if the remaining states implemented expansion. This includes at least 2.4 million people of color, 500,000 people with disabilities, and almost a million older Americans who are currently uninsured. Additionally, research shows that Medicaid expansion helps increase coverage rates for children. 
  • Even after paying the cost of Medicaid expansion, these states would receive an additional $9.6 billion in new federal funding that they could use to offset spending in other state programs or budget shortfalls. According to estimates from the Kaiser Family Foundation, the 14 states that have not yet implemented Medicaid expansion would receive $16.4 billion thanks to the enhanced federal match rate under the American Rescue plan, while the total cost of Medicaid expansion in these states would only be $6.8 billion.

Expands Medicaid Coverage To New Mothers One Year Postpartum. Women in the United States are more likely to die during childbirth than in peer nations, and Black women are three to four times more likely to die of complications related to pregnancy and childbirth compared to white women. A recent study from the Urban Institute found that 20 percent of uninsured new mothers skipped care because of cost, and half worried about not being able to afford medical bills. The American Rescue Plan works to address the maternal mortality crisis by enabling states to expand Medicaid coverage to new mothers 12 months postpartum. This is particularly important in non-expansion states, where many new mothers fall into the coverage gap. 

Includes Funding To Ensure Medicaid Patients Can Get COVID-19 Treatment & Vaccinates For Free. The American Rescue Plan includes federal funding to provide COVID-19 treatment and vaccines at no cost to Medicaid recipients. The ARP also gives 100 percent federal match funding to states that choose to provide vaccines and treatment to the uninsured without cost sharing. Efforts to increase vaccination will be especially beneficial in communities of color and hard to reach populations.

Invests In Medicaid Home- And Community-Based Services (HCBS). HCBS help seniors and people with disabilities live and age independently at home and in their communities. Under the American Rescue Plan, states will receive a 10 percentage point increase in federal matching funds through March 2022 to strengthen Medicaid HCBS. The American Rescue Plan also includes additional funding for Medicaid-certified nursing facilities experiencing COVID-19 outbreaks. 

Invests $8.5 Billion In Relief Payments For Rural Medicaid Providers. Rural hospitals have taken a serious financial hit during the pandemic. Per the Kaiser Family Foundation, “These funds are available to compensate for health care related expenses and lost revenues attributable to the pandemic for rural providers who diagnose, test, or care for individuals with possible or actual COVID-19.” 

Provides Additional Funds For Community-Based Mobile Crisis Intervention Services. The American Rescue Plan gives states the option to provide community-based mobile crisis intervention services with 85 percent federal matching funds for three years. These services help people experiencing issues with mental health and substance use disorder. 

Lifts The Medicaid Drug Rebate Cap. Eliminating the cap on prescription drug rebates that manufacturers pay to state Medicaid programs would bring significant savings to state budgets as they recover from the economic toll of the pandemic. 

protectourcare
In Fact Sheet

ACA At 11: Protections For People With Pre-Existing Conditions

Protect Our Care Is Marking the 11th Anniversary of the Affordable Care Act With 11 Days Celebrating the Success of the Health Care Law

Eleven years ago, the Affordable Care Act (ACA) became the law of the land and millions of people gained coverage and critical protections as a result. Because of the ACA, insurers in the individual market can no longer drop or deny coverage, or charge people more because of a pre-existing condition. More than 135 million Americans have a pre-existing health condition, such as asthma, diabetes, or cancer. 

After four long years of Republican efforts to repeal and sabotage the law, President Biden and Democrats in Congress are now working to build on the strong foundation of the ACA to expand coverage, lower costs, and reduce racial disparities in health care. On March 11, President Biden signed the American Rescue Plan into law, historic legislation that includes the most significant health care expansion in a decade. Solidifying and expanding the ACA is especially important as millions of Americans have contracted the COVID-19; without the health law’s protections, survivors of COVID-19 would likely be deemed as having a pre-existing condition and be at the mercy of their insurance companies who could refuse to pay for needed care. 

At the same time, millions have lost their jobs and their employer-sponsored coverage during the pandemic, and experts say an overwhelming majority have been able to get covered under the ACA — through the marketplaces or through Medicaid expansion. Every single one of these individuals now relies on the ACA’s protections for pre-existing conditions. 

The ACA Includes Four Key Provisions That Protect People With Pre-Existing Conditions: 

  • COVERAGE GUARANTEE: Rule that forbids insurance companies from denying coverage to people with pre-existing conditions. 
  • COST: Rule that prevents insurers from charging people with pre-existing conditions more. 
  • ESSENTIAL HEALTH BENEFITS: Requirements that insurance companies cover essential health benefits, such as prescription drugs and maternity care.
  • LIFETIME CAPS: Ban on insurance companies having lifetime caps on coverage.

The ACA Prevents Insurance Companies From Charging Americans With A Pre-Existing Condition More, Or Denying Them Coverage Altogether. Prior to the ACA, insurance companies were allowed to charge people more or deny coverage simply because they had a pre-existing condition. The ACA banned this practice, requiring that insurance companies offer people coverage regardless of their health status. Without the ACA, premium surcharges could once again be in the six figures for some conditions. 

The ACA Guarantees Comprehensive Coverage. Because of the ACA, insurers have to cover what are known as “essential health benefits,” such as maternity care, prescription drugs, and substance and mental health. Importantly, ACA-compliant plans must cover COVID-19 testing, treatment, and hospitalization. Before the ACA, individual market plans often failed to cover these basic health services.  

The ACA Ended Annual And Lifetime Limits, Including For People With Employer-Based Coverage. Because of the ACA, insurers can no longer put annual or lifetime limits on the care you receive. At the time the ACA was passed, 91 million Americans had health care through their employers that imposed lifetime limits. Many such plans capped benefits at $1 million, functionally locking people with complex medical needs out of coverage. 

A Closer Look At Who Has Pre-Existing Conditions In The U.S.

Before the Affordable Care Act, insurance companies routinely denied people coverage because of a pre-existing condition or canceled coverage when a person got sick. According to an analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 135 million people, have a pre-existing condition. This includes:

  • 44 million people who have high blood pressure
  • 45 million people who have behavioral health disorders
  • 44 million people who have high cholesterol
  • 34 million people who have asthma and chronic lung disease
  • 34 million people who have osteoarthritis and other joint disorders

More than 17 million children, 68 million women, and 32 million people aged 55-64 have a pre-existing condition.

The Kaiser Family Foundation estimates that 54 million people, or 27 percent of adults aged 18 to 64, have a condition that would have been grounds for coverage denial in the pre-ACA marketplace. Recent survey data found that six in 10 say they or someone in their household suffers from a pre-existing condition, such as asthma, diabetes, or high blood pressure. 

protectourcare
In Fact Sheet

ACA At 11: Women’s Coverage

Protect Our Care Is Marking the 11th Anniversary of the Affordable Care Act With 11 Days Celebrating the Success of the Health Care Law

Eleven years ago, the Affordable Care Act (ACA) became the law of the land and millions of women gained coverage and critical protections as a result. Among the many benefits of the ACA, the health care law ensures that women cannot be charged more than men for the same coverage. Additionally, 68 million women with pre-existing conditions like diabetes and asthma are protected from discrimination, and they are no longer subject to annual or lifetime limits. The ACA also guarantees free preventive care, such as mammograms, Pap smears, and other important screenings, in addition to providing birth control with no out-of-pocket fees. These benefits, along with creation of the ACA Marketplace and expansion of Medicaid, have improved the health of women across the country. 

After four long years of Republican efforts to repeal and sabotage the law, President Biden and Democrats in Congress are now working to build on the strong foundation of the ACA to expand coverage, lower costs, and reduce racial disparities in health care. On March 11, President Biden signed the American Rescue Plan into law, historic legislation that includes the most significant health care expansion in a decade. Making coverage more affordable and accessible is essential as millions of women have lost their jobs and their health insurance during the COVID-19 pandemic. Protect Our Care recently released a report detailing the impact of the American Rescue Plan on women’s lives. 

Thanks To The ACA: 

  • 68 Million Women With Pre-Existing Conditions Cannot Be Charged More Or Denied Coverage. Prior to the ACA, conditions like asthma, diabetes, and even pregnancy were grounds for insurance companies to charge more or deny coverage altogether. Additionally, insurance companies could impose annual and lifetime limits on coverage, which further eroded access to care for the sickest patients. 
  • Women Cannot Be Charged More Than Men For The Same Coverage. Before the ACA, women were often charged premiums on the nongroup market of up to 50 percent higher than men for the same coverage, and 1 in 5 women reported postponing or going without preventive care due to cost. Thanks to the ACA, insurers cannot charge women more than men for the same coverage, and women gained access to important preventive care services with no out-of-pocket costs. 
  • More Than 60 million People Have Access To Birth Control With No Out-Of-Pocket Fees. The ACA guarantees that private health plans cover 18 methods of contraception and make them available to 62.4 million patients with no out-of-pocket costs. More than 99 percent of sexually-active women have used contraceptives at some point in their lifetimes, and approximately 60 percent of women of reproductive age currently use at least one birth control method. In addition to increasing access to this essential treatment, this ACA provision has saved money for women and their families: women saved $1.4 billion on birth control pills alone in 2013.
  • Women Can No Longer Face Discrimination In Health Care Settings. Section 1557 of the ACA prohibits discrimination the basis of race, color, national origin, sex, age, or disability by any health program or activity receiving federal assistance. It also prohibits these types of discrimination in health programs and activities administered by HHS as well as the ACA marketplaces. 
  • Nursing Parents Gained Breastfeeding Support And Critical Workplace Protections. The Affordable Care Act requires insurance companies to cover breastfeeding support and counseling as well as breast pumps without cost-sharing for pregnant and nursing women. 

A Closer Look At How The Affordable Care Act Is Working For Women Across The Country:

The Number Of Uninsured Women In The U.S. Fell By Nearly Half Between 2010 And 2016. The number of women lacking health insurance had fallen by almost half between 2010 and 2016, from 19 million to 11 million. The uninsured rate for women with low incomes fell from 34 percent to 18 percent over the same period. 

The ACA Improved Women’s Access To Care. Studies have shown that women with insurance are far more likely to receive preventive care, including mammograms. According to the Commonwealth Fund, the percentage of women skipping needed care, including filling a prescription, going to the doctor, or receiving recommended care, dropped from 48 percent in 2010 to 38 percent in 2016. Additionally, the number of women reporting problems with medical bills declined after the implementation of the ACA. The Center for American Progress found that, by 2014, Black women were already more likely to receive care because of the ACA. 

The ACA’s Medicaid Expansion Improved Maternal Health. Research from the Georgetown Center for Children and Families found that Medicaid expansion has helped fill gaps in maternal health coverage, leading to healthier mothers and babies. It also helps new mothers maintain access to coverage and important postpartum care after giving birth. Multiple studies draw the connection between Medicaid expansion and reduced infant and maternal mortality rates. One study found that reductions in maternal mortality in expansion states were concentrated among Black mothers, “suggesting that expansion could be contributing to decreasing racial disparities in maternal mortality.” Medicaid expansion has also been tied to improving access to birth control and family planning. 

Sean England
In Fact Sheet

As Health Care Takes Center Stage, Protect Our Care Releases Agenda to Lower Costs, Improve Care and Reduce Inequities

Protect Our Care Says Key Health Care Measures Must Be Included As Congress Considers COVID Relief and Budget Reconciliation 

Read the Agenda Here

Washington, DC — Today, Protect Our Care released a health care agenda detailing steps President Biden and the Democratic-controlled Congress should take to improve Americans’ health care. The agenda lays out both administrative and legislative actions to expand coverage, lower costs, strengthen protections and address inequities in care. The agenda comes as the Biden administration prepares to sign executive orders related to health care, presses forward with the American Rescue Plan, which includes key health care affordability provisions, and Congress prepares to move forward on budget reconciliation if Republicans fail to agree to the rescue plan America needs.   

“Protect Our Care’s health care agenda lays out common sense measures in line with what Democrats, including President Biden, have run and won on when it comes to health care. These provisions will increase coverage and lower costs, and they are even more important as Americans battle the pandemic. President Biden has put health care front and center since taking office by prioritizing critical executive orders that make sure more Americans can get covered and remove barriers to enrolling in Medicaid. We look forward to working with President Biden and Democratic leaders in Congress to move our common agenda forward,” said Protect Our Care Executive Director Brad Woodhouse. 

“President Biden’s American Rescue Plan includes strong provisions to reduce the cost of health insurance for millions of Americans and get millions more covered. Polling shows that large majorities of Republican voters support these provisions, and Republican members of Congress should support them too. And if Republicans refuse, any COVID relief budget reconciliation plan should include them. That’s what Americans want and expect. Americans cannot afford to wait any longer,” said Protect Our Care Chair Leslie Dach.

protectourcare
In Fact Sheet

Protect Our Care Praises Biden’s ‘American Rescue Plan’

Along with Delivering Relief to Americans and Fixing Problems with the Vaccine Distribution Rollout, Biden’s Ambitious Plan Will Make Health Care More Accessible and Addresses Racial Disparities

Washington, DC — Following President-elect Joe Biden’s release of his ‘American Rescue Plan,’ Protect Our Care Executive Director Brad Woodhouse issued the following statement:

“We commend President-elect Biden for putting forth a package to address the disaster he will inherit from Donald Trump and his failed leadership. It will take time to fill the steep hole this administration has left us in, but delivering relief into the hands of Americans, fixing Trump’s disastrous vaccine distribution rollout, and getting resources to states and localities are vital to rescuing our nation from a pandemic that has gone on far too long and been far too costly to the American people. Importantly, this package includes crucial provisions to expand health care coverage, make accessing health care more affordable and address racial disparities in coronavirus treatment and outcomes.

“During the entirety of this pandemic, President Trump and Republicans refused to lift a finger to help people get covered or make health care more affordable. In fact, the Trump administration is before the Supreme Court right now trying to rip coverage away; but President-elect Biden is doing the right thing by working to preserve and expand health care coverage and end the pandemic. Congress should move quickly to provide this much needed relief for Americans.”

Sean England
In Fact Sheet, Research

Fact Sheet On Trump Lawsuit To Overturn ACA

With a vacancy on the U.S. Supreme Court, the future of our health care is at stake. On November 10, 2020 — one week after the election — the U.S. Supreme Court will hear oral arguments in California v. Texas, a case that, if successful, would overturn the entire Affordable Care Act (ACA), ending its protections for 135 million Americans with pre-existing conditions and ripping health care away from more than 20 million Americans, all during a raging pandemic. The danger of letting Donald Trump fill the Supreme Court vacancy cannot be overstated. Now, more than ever, Americans’ health care is on the ballot.

If the Affordable Care Act is struck down:

  • GONE: Protections for 135 million Americans with pre-existing conditions. The uninsured rate will increase by 65 percent. 
  • GONE: Medicaid expansion, which covers more than 15 million people. 
  • GONE: Nearly 12 million seniors will have to pay more for prescription drugs because the Medicare ‘donut hole’ will be reopened.
  • GONE: 2.3 million adult children will no longer be able to stay on their parents’ insurance. 
  • GONE: Insurance companies will be able to charge women 50 percent more than men.
  • GONE: Financial assistance that helps 9 million people purchase health care in the marketplace.
  • GONE: Key support for rural hospitals. 
  • GONE: Ban on insurance companies having lifetime caps on coverage.
  • GONE: Requirements that insurance companies cover prescription drugs and maternity care.
  • GONE: 60 million Medicare beneficiaries will face higher costs and disruptions to their medical care. 

Thanks To The Republican Lawsuit, More Than 20 Million People Could Lose Their Coverage

  • 20 million people could lose coverage. The Center for American Progress estimates more than 20 million people could lose coverage during an ever-worsening global pandemic if the ACA is overturned.
  • The uninsured rate would increase by at least 65 percent. According to pre-pandemic estimates from the Urban Institute, the number of uninsured Americans would increase from 30.4 million to 50.3 million without the ACA, representing a 65 percent increase in the uninsured rate. As the uninsured rate swells, so will the amount of uncompensated care, which Urban predicts will grow by at least 82 percent.
  • States would lose important federal health care funding — an estimated reduction of $135 billion in the first year. The Urban Institute estimates that a full repeal of the ACA would reduce federal spending on Medicaid/CHIP care and Marketplace subsidies by $135 billion, or 34.6 percent in the first year.
  • Millions of children could lose their coverage. Almost three million children nationwide gained coverage thanks to the ACA. If the law is overturned, many of these children will lose their insurance.
  • The Black uninsured rate would spike to 20 percent. According to the Center on Budget and Policy Priorities, the ACA helped lower the uninsured rate for nonelderly African Americans by more than one third between 2013 and 2016 from 18.9 percent to 11.7 percent. Without the ACA, the uninsured rate for black Americans would spike to 20 percent.
  • 5.4 million Latinos would lose coverage. The percentage of people gaining health insurance under the ACA was higher for Latinos than for any other racial or ethnic group in the country. According to a study from Families USA, 5.4 million Latinos would lose coverage if the lawsuit succeeds in overturning the ACA.

Republicans Want To Put Insurance Companies Back In Charge, Ending Protections For The 135 Million People With A Pre-Existing Condition

  • According to a recent analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 135 million people, have a pre-existing condition. This includes:
    • 44 million people who have high blood pressure
    • 45 million people who have behavioral health disorders
    • 44 million people who have high cholesterol
    • 34 million people who have asthma and chronic lung disease
    • 34 million people who have osteoarthritis and other joint disorders

Republicans Want To Give Insurance Companies The Power To Deny Or Drop Coverage Because Of A Pre-Existing Condition

Conditions That Could Cost You Your Care:

  • AIDS/HIV
  • Alcohol/drug Abuse
  • Cerebral Palsy
  • Cancer
  • Heart Disease
  • Diabetes
  • Epilepsy
  • Kidney Disease
  • Severe Epilepsy
  • Sleep Apnea
  • Pregnancy
  • Muscular Dystrophy
  • Depression
  • Eating Disorders
  • Bipolar Disorder
 Jobs You Could Be Denied Coverage Because Of:

  • Active military personnel
  • Air traffic controller
  • Body guard
  • Pilot
  • Meat packers
  • Taxi cab drivers
  • Steel metal workers
  • Law enforcement 
  • Oil and gas exploration
  • Scuba divers
 Medications That You Could Be Denied Health Care For Taking:

  • Anti-arthritic medications
  • Anti-diabetic medications (including insulin)
  • Anti-cancer medications
  • Anti-coagulant and anti-thrombotic medications
  • Medication for autism
  • Anti-psychotics
  • Medications for HIV/AIDS
  • Growth hormone
  • Medication used to treat arthritis, anemia, and narcolepsy
  • Fertility Medication

Before the Affordable Care Act, insurance companies routinely denied people coverage because of a pre-existing condition or canceled coverage when a person got sick. Now insurance companies could have the license to do this again. 

  • A 2010 congressional report found that the top four health insurance companies denied coverage to one in seven consumers on the individual market over a three year period. 
  • A 2009 congressional report found that some of the largest insurance companies had retroactively canceled coverage for 20,000 people over the previous five year period.
  • The Kaiser Family Foundation estimates that 54 million people, or 27% of adults aged 18 to 64, have a condition that would have been grounds for coverage denial in the pre-ACA marketplace. 
  • An analysis by Avalere finds that “102 million individuals, not enrolled in major public programs like Medicaid or Medicare, have a pre-existing medical condition and could therefore face higher premiums or significant out-of-pocket costs” if the Trump-GOP lawsuit is successful.

Coronavirus Could Now Be Considered A Pre-Existing Condition. Without the ACA, millions of Americans who have contracted the coronavirus would likely be deemed as having a pre-existing condition and be at the mercy of their insurance companies who could refuse to pay for needed care. Because of Donald Trump’s failure to respond to the coronavirus crisis, the number of Americans with coronavirus is only increasing, with hundreds of thousands of cases still being reported every week. 

Republicans Want To Give Insurance Companies The Power To Charge You More, While Their Profits Soar

  • 138 Million Americans Could Once Again Have To Pay For Preventive Care. Because of the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no cost to consumers. This includes nearly 138 million Americans, most of whom have employer coverage.
  • Premium Surcharges Could Once Again Be In The Six Figures. Thanks to the Republican lawsuit, insurance companies could once again charge people more because of a pre-existing condition. The House-passed repeal bill had a similar provision, and an analysis by the Center for American Progress found that insurers could charge up to $4,270 more for asthma, $17,060 more for pregnancy, $26,180 more for rheumatoid arthritis and $140,510 more for metastatic cancer.
  • Women Could Be Charged More Than Men For The Same Coverage. Prior to the ACA, women were often charged premiums on the nongroup market of up to 50 percent higher than they charged men for the same coverage. 
  • People Over The Age of 50 Would Face A $4,000 “Age Tax.” Thanks to the Republican lawsuit, insurance companies could charge people over 50 more than younger people. The Affordable Care Act limited the amount older people could be charged to three times more than younger people. If insurers were to charge five times more, as was proposed in the Republican repeal bills, that would add an average “age tax” of $4,124 for a 60-year-old in the individual market, according to the AARP.
  • Nine Million People In The Marketplaces Would Pay More For Coverage. If the ACA is overturned, consumers would no longer have access to tax credits that help them pay their marketplace premiums, meaning roughly nine million people who receive these tax credits to pay for coverage would have to pay more.
  • Seniors Would Have To Pay More For Prescription Drugs. Thanks to the Republican lawsuit, seniors would have to pay more for prescription drugs because the Medicare “donut” hole would be reopened. From 2010 to 2016, “More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary,” according to a January 2017 Centers on Medicare and Medicaid Services report.
  • 60 Million Medicare Beneficiaries Could Face Higher Costs. In addition to paying more for preventive care and prescription drugs, Medicare beneficiaries could face higher premiums without the cost-saving measures implemented under the ACA. If the Republican lawsuit is successful, seniors would also face less coordinated care. 

Republicans Want To Give Insurance Companies The Power To Limit The Care You Get, Even If You Have Insurance Through Your Employer

  • Insurers Could Reinstate Lifetime and Annual Limits On 109 Million Privately Insured Americans. Repealing the Affordable Care Act means insurance companies would be able to impose annual and lifetime limits on coverage for those insured through their employer or on the individual market. In 2009, nearly 6 in 10 (59%) covered workers’ employer-sponsored health plans had a lifetime limit, according to the Kaiser Family Foundation. 
  • Insurance Companies Would Not Have to Provide the Coverage You Need. The Affordable Care Act made comprehensive coverage more available by requiring insurance companies to include “essential health benefits” in their plans, such as maternity care, hospitalization, substance abuse care and prescription drug coverage. Before the ACA, people had to pay extra for separate coverage for these benefits. For example, in 2013, 75 percent of non-group plans did not cover maternity care, 45 percent did not cover substance abuse disorder services, and 38 percent did not cover mental health services. Six percent did not even cover generic drugs.
  • Large Employers Could Choose to Follow Any State’s Guidance, Enabling Them Put Annual and Lifetime Limits on Their Employees’ Health Care. Without the ACA’s definition of essential health benefits (EHB), states could eliminate them altogether. Large employers could choose to apply any state’s standard, making state regulations essentially meaningless. Because the prohibition on annual and lifetime limits only applies to essential health benefits, this change would allow employers to reinstate annual and lifetime limits on their employees’ coverage.

Republicans Want To End Medicaid Expansion

  • More Than 15 Million People Enrolled Through Medicaid Expansion Would Lose Coverage. Before the coronavirus crisis, roughly 15 million people were enrolled through Medicaid expansion. 
  • Medicaid Plays A Critical Role In The Coronavirus Response. An estimated 12 million people have lost their employer-sponsored coverage as a result of the pandemic, and states are reporting steep increases in Medicaid enrollment. The Center on Budget and Policy Priorities found that roughly 6 million people enrolled in Medicaid between February and July 2020.  
  • Access To Treatment Would Be In Jeopardy For 800,000 People With Opioid Use Disorder. Roughly four in 10, or 800,000 people with an opioid use disorder are enrolled in Medicaid. Many became eligible through Medicaid expansion.
  • Key Support For Rural Hospitals Would Disappear, with state spending on Medicaid/CHIP falling by $9.6 billion. 
Sean England
In Fact Sheet

Lower Costs, Better Care: House Dems Unveil Sweeping Health Bill

After winning the Midterm elections by vowing to fight for Americans’ health care, Democrats in the House of Representatives are making good on their promises by introducing sweeping legislation to achieve lower costs and better care. While House Democrats take concrete steps to make our health care system work better for the American people, the Trump administration and its Republican allies are doing just the opposite: proposing to cut Medicare and Medicaid by $2 trillion, gutting protections for preexisting conditions, and throwing the full weight of the Justice Department behind overthrowing the Affordable Care Act in the Texas lawsuit.

This bill is only the start for the Democrats’ agenda which will ultimately include further efforts to rein in prescription drug costs and end surprise hospital bills. Here’s how the proposed legislation will work for Americans:

Lower Health Care Costs. The House bill would reduce health care premiums and deductibles, expand eligibility for financial assistance that helps consumers afford coverage, and expand access to affordable health care by guaranteeing affordable care options.

  • Coverage for less than ten percent of your income. Under the bill, nearly all Americans would be guaranteed an option to purchase health care for less than 10 percent of their income.
  • Financial assistance for more people. Premium tax credits would be made available to more middle class Americans, including those with incomes above 400 percent of the federal poverty line or roughly $100,400 for a family of four.
  • Lowering premiums. By creating a national reinsurance program the House legislation would help further reduce premiums.

Better Care For More People. The bill would restrict insurance companies’ ability to sell plans that gut circumvent important consumer protections. By helping to lower costs, the House bill would also expand access to comprehensive, affordable care for even more people.

  • Lowering premiums, deductibles, or both for more than 13 million people currently insured and providing lower cost options for 12 million uninsured people. In all, the bill’s extended tax credits, reinsurance programs and premium assistance would cut premiums for all ACA-compliant plans sold on the individual market, reducing premiums or deductibles for 13 million with individual market coverage and creating lower cost options for 12 million uninsured people eligible for coverage through the marketplace.
  • Protecting people with pre-existing conditions. The legislation would stop the Trump administration’s plans to allow insurance companies to sell junk plans that deny people with pre-existing conditions coverage or charge them more.
  • Guaranteeing that insurance companies cover basic health services. The bill would also prevent the Trump administration from weakening requirements that all insurance cover essential health benefits, such as prescription drug coverage, hospital care, and maternity coverage.
  • Taking power away from insurance companies and gives it back to patients. While the Trump administration gives insurance companies the power to flood the market with junk plans and rewards them with massive tax breaks, this bill reinstates important protections for American consumers, giving power back to patients.

End Sabotage. Since taking office, the Trump administration has worked relentlessly to sabotage Americans’ health care, expanding access to junk plans that allow insurance companies to deny coverage to patients with pre-existing conditions and slashing funding to help people sign up for comprehensive, affordable care.

  • Restoring funding for education. The House bill would restore marketing funding for heatlh care sold through the marketplace, which the Trump administration has cut by 90 percent since taking office.

Restoring funding for groups that help people sign up for coverage. Funding for health navigator groups that help people sign up for comprehensive care, which has been cut by 77 percent since the President Trump took office, would also be restored.

Sean England
In Fact Sheet

The Republican War On Medicaid

President Trump and Republicans in Congress have waged a relentless war on Medicaid. Their war on Medicaid is a war on children, seniors, people with disabilities, rural Americans, those fighting the opioid crisis, our schools, and everyone else who benefits from Medicaid.  

FRONTAL ATTACK — REPUBLICANS HAVE REPEATEDLY TRIED EVISCERATING MEDICAID

Despite repeatedly promising not to cut Medicaid when he ran for president in 2017, President Trump’s latest budget  called for $1.5 trillion in cuts to Medicaid. Trump’s lawsuit to fully repeal the Affordable Care Act would end Medicaid expansion, kicking 12.7 million who depend on the program off their insurance.

With the support of the Trump Administration, House Republicans in 2017 voted to repeal the ACA — the American Health Care Act (AHCA) — which would have cut Medicaid by $834 billion and turned it into a per capita program. The Senate repeal bill — Graham-Cassidy —  would have slashed Medicaid funding by $4 trillion over 20 years.

SABOTAGE ATTACK — ONEROUS REQUIREMENTS

When they are not calling for dramatic cuts to Medicaid, Republicans are finding other ways to sabotage the program. For instance, Republicans in state after state are proposing illegal and burdensome “work requirements” which do nothing but take health care away from people who need it. Medicaid work requirements are blatantly designed to strip health care away from low-income Americans. Thankfully, they have now been declared illegal by multiple courts. Republican governors now want to appeal these decisions.

Despite these court decisions, President Trump’s 2020 budget proposed a nationwide work requirement which experts estimate will cause up to 4 million people to lose coverage, mostly due to paperwork and red tape. More than 18,000 people lost their Medicaid in Arkansas because of the work requirement the courts have now overturned.

In November’s elections, voters moved to expand Medicaid in three states and elect pro-Medicaid governors in even more. Now, Republlican officials are doing everything in their power to deny voters’ will in states that elected to expand Medicaid and prevent Medicaid expansion initiatives in states now starting to consider them. Just last week the Trump administration approved a request from Utah to cap its Medicaid enrollment, fundamentally restricting the number of people who can access life-saving health care.

WHO BENEFITS FROM THE GOP WAR ON MEDICAID? THE WEALTHY AND BIG CORPORATIONS

In 2017, President Trump signed a $1.5 trillion tax bill that disproportionately benefits the wealthy and that is already padding health company’s profits. How do Republicans plan on paying for it? Former Speaker Ryan’s answer left no doubt: “Frankly, it’s the health care entitlements that are the big drivers of our debt.” In an attempt to pay for these tax cuts, last April, House Republicans passed a balanced budget amendment that would slash Medicaid funding by $114 billion in a single year alone. President Trump’s fiscal 2020 budget called for $1.5 trillion in cuts over ten years.

The Republican plan is clear: give companies like drug giant Pfizer a $563 million tax benefit, and make low and middle income Americans pay the price.

WHO GETS HURT FROM THE GOP WAR ON MEDICAID? PRETTY MUCH EVERYONE ELSE.

  • Children & Families. Roughly 34.9 million children in the United States are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). Nationally, nearly 2 in 5, or 39% of children in America have health insurance through Medicaid, as do 17 Percent of parents. 49 percent of births are covered by Medicaid.
  • Seniors. More than 6.9 million American seniors have Medicaid coverage. More than 8.5 million Americans ages 50 to 64 have health coverage through Medicaid. Medicaid covers 6 in 10 nursing home residents.
  • People with disabilities. Nearly 8.7 million adults enrolled in Medicaid have a disability. Of this group, only 43 percent qualify for social security income. More than 1 in 3 adults under age 65 enrolled in Medicaid lives with at least one disability. Medicaid covers 45 percent of nonelderly adults with disabilities, including adults with physical disabilities, developmental disabilities, brain injuries, and mental illness.
  • People in rural areas. The ACA has expanded access to health care to nearly 1.7 million rural Americans who have gained coverage through the Medicaid expansion, not only playing a central role in improving rural communities’ health, but also supporting these communities’ economic well-being. Medicaid covers nearly 24 percent of rural Americans, 45 percent of rural children, 15 percent of rural seniors, and pays for 51 percent of rural births. The uninsured rate in rural areas in states that expanded Medicaid has dropped by a median of 44 percent since expansion.
  • Fighting the opioid crisis. More than half of people with an opioid use disorder earn incomes below 200 percent of the federal poverty line. In 2014, Medicaid paid for 25 percent of all addiction treatment nationwide. It is estimated that Medicaid expansion covers four in ten people with an opioid use disorder.
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